A Midsized Plan Successfully Implemented HEDIS with Help from Change Healthcare Consulting

Change Healthcare Consulting helped a fast-growing, midsized plan that was behind in pulling together its HEDIS data and had no trained in-house staff build the foundation of its HEDIS program, doing nearly 18 months of work in just four months. The result: The plan completed its HEDIS audit on time and did so with no audit findings. The speed and thoroughness of the project helped the plan with its NCQA accreditation. 


A fast-growing, midsized plan that was charged with building the foundation of their HEDIS program while onboarding and training new staff. Change Healthcare Consulting helped the plan pull all the requirements together in record time, doing nearly 18 months of work in just four months. 


Change Healthcare Consulting 


The plan completed its HEDIS submission on time — and with no audit findings. The speed and thoroughness of the project helped the plan with its NCQA accreditation.

Cutting HEDIS Submission Time from 18 Months to Just Four

The midsized, fast-growing Medicaid plan, which had relied on a third-party administrator for most administrative services, had just begun to insource these services. However, no one inside the plan had the skills and experience to gather the necessary data and documentation to organize a Healthcare Effectiveness Data and Information Set (HEDIS) submission—a vital, necessary component for NCQA accreditation.

The plan asked Change Healthcare Consulting to help it build the foundation of a HEDIS program. Normally, plans start this work 12 to 18 months before a HEDIS submission. With a shortened turnaround time and Change Healthcare Consulting’s help, the plan was able to gather the data, document processes, and submit rates in just four months. Not only was the plan able to complete all requirements for the HEDIS audit on time, it did so with no audit findings.

To comply with a HEDIS auditor’s standards, all plans need to supply appropriate data to their HEDIS engines or vendors according to an exacting set of rules and specifications.

In the case of Change Healthcare Consulting’s client, this was problematic because old data from the previous third-party administrator needed to be converted to match the format and definitions of the new data. Moreover, the data needed to be combined into unified data sets for the plan’s HEDIS look-back period.

More Than Collecting Data, Change Healthcare Consulting Works on the HEDIS Roadmap

In addition to collecting and transforming the data, HEDIS submission requires accompanying documentation. The HEDIS Roadmap documents how your organization’s policies, procedures, and information-management practices affect HEDIS reporting.

Completing a HEDIS road map is an arduous task, requiring a plan to submit hundreds of documents detailing data flow, workflow, policies, procedures, and evidence of quality, as well as descriptions of its data and business processes. In this case, the plan asked Change Healthcare Consulting to help not only with HEDIS submission but also to produce its HEDIS Roadmap, a task which included interviews as well as educating and training health plan staff. For Change Healthcare Consulting, the entire project—submission and Roadmap—involved interviewing, educating, and training health plan staff in operations, understanding the components of data quality, and overall best practices.

Change Healthcare Consulting understands that HEDIS is everyone’s business. By helping plans with HEDIS certification and NCQA accreditation, Change Healthcare consultants can help plans not only meet federal and state requirements but also promote the highest level of healthcare delivery.

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